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EW CATARACT 45 There was more of a difference in the post-cataract endophthalmitis group, with mean improvement in the steroid group at 4.1 lines (range –3-9) compared to only 2.7 lines (range –3-9) in the placebo group. "Although small numbers meant that the p value was only 0.330, a clinically significant benefi- cial trend was demonstrated," Dr. Albrecht wrote. There is much less understand- ing of the impact of steroids in other endophthalmitis groups. "The role of intravitreal steroids was inconclusive in the bleb-related endophthalmitis group and the other endophthalmitis group as the very low numbers in each group re- sulted in p values of nearly 1," Dr. Albrecht reported. "The number of lines of improvement/deterioration and the final visual categories achieved in each group appeared clinically similar." Importantly, though, Dr. Albrecht found that no adverse reac- tions were caused directly by steroid usage. In one previous report, Gan et al found a trend of better visual acuity in a dexamethasone/antibiotic group who had post-op endoph- thalmitis. Outcomes were measured at 3 and 12 months. A placebo was used as a control in that study, which included 29 patients. However, another previous re- port by Shah et al found that in 57 endophthalmitis cases, patients who were given intravitreal antibiotics alone did better than patients who received intravitreal steroids alone. "Patients who received steroids had a significantly reduced likeli- hood of obtaining 3-line improve- ment," Dr. Albrecht noted. All of these studies had rela- tively small patient populations, which subjects them to being statis- tically weak. Dr. Albrecht believes there is merit in combining the re- sults, however. "We had only 25% power to de- tect a statistically significant differ- ence between those randomised to steroid and placebo in the post cataract subgroup," Dr. Albrecht re- ported. "Although the results from this study did not achieve statistical significance, when we combined these findings with those of Gan et al, whose results were highly consis- tent, the resulting measure of the benefit of steroid in preventing poor visual outcome is clear. Although caution must be exercised in merg- ing the data from two studies with slightly different methods, manage- ment practices and determination of outcomes, this analysis points to the likely value of steroids in post cataract endophthalmitis." John D. Sheppard, M.D., pro- fessor of ophthalmology, microbiol- Post-op predictability you can count on with the EX-PRESS ® Glaucoma Filtration Device. The peace of predictability. © 2011 Novartis AG 7/11 EXP10587JAD EyeWorld 8/11 76011 EXP10587JAD EW.indd 1 7/12/11 2:07 PM September 2011 continued on page 46

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